Medical Coding & Billing Specialist

OneOncology

About The Position

The Medical Coding and Billing Specialist writes and maintains coding and billing rules in the practice management system, reviews and imports daily charges in Radiology Authorization Specialist, and files daily claims. The role supports accurate and timely billing for proton therapy, radiation therapy, and radiology services, including insurance verification, claim monitoring and resolution, coding compliance, and record maintenance. The specialist works under the direct supervision of the respective team manager and collaborates with clinical, pre-authorization, and practice leadership teams. Additional responsibilities may be assigned in support of OneOncology’s mission.

Requirements

At least two years of charge-entry or billing experience.
At least one year of prior authorization experience.
Extensive knowledge of CPT, HCPCS, and ICD-9 coding and insurance billing guidelines.
Medical insurance background.
Expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid.
Proficiency with Microsoft Excel spreadsheets and a strong computer background.
Ability to use end-user computer applications, including MS Word, Excel, and Outlook, as well as databases, patient scheduling systems, and other medical information systems.
Ability to work effectively with all levels of management and colleagues.
Ability to demonstrate initiative, mature judgment, professionalism, and adaptability.
Strong customer service skills.
Ability to use websites, portals, and electronic options to improve efficiency.
Ability to follow oral and written instructions.
Problem-solving ability, creative thinking, hands-on problem-solving skills, and the ability to analyze and respond to data.
Effective verbal and written communication, active listening, and the ability to present findings and recommendations.
Multitasking and organizational skills, with strong attention to detail.
Working knowledge of hospice and other payer requirements.
Knowledge of clinic office procedures, medical practice, and medical terminology.
Must be willing and able to lift up to 25 pounds.
Must be willing and able to travel to satellite clinics when necessary.
Attendance is an essential job function.

Nice To Haves

Bachelor’s degree preferred.

Responsibilities

Review and verify patient insurance coverage and eligibility for proton therapy treatments.
Ensure applicable proton therapy, radiation therapy, and radiology charges are entered accurately and on time in the practice management system.
Generate and submit accurate, timely claims to insurance payers for proton therapy, radiation therapy, and radiology services.
Monitor claims through the billing process, track payment, and identify payer roadblocks.
Investigate and help resolve claim rejections, denials, and appeals related to proton therapy treatments.
Review and interpret insurance policies and regulations relevant to proton therapy billing and compliance.
Work with the proton therapy center’s medical and pre-authorization teams to ensure complete and accurate billing for proton therapy and radiation therapy treatments.
Maintain accurate, up-to-date billing records in patient files and computer systems.
Review and interpret radiation oncology medical records for coding and billing accuracy, and educate the clinical team on documentation requirements.
Assist team members in responding professionally and promptly to patient and insurer billing inquiries.
Stay current on industry trends, insurance policy changes, and developments that may affect proton therapy and radiation therapy billing.
Review charges in “Approve Failed” status daily and take corrective action as needed.
Contact appropriate departments to follow up on pending insurance and referral issues.
Work Research ACE tasks in Unity daily.
Review charges on “Hold” status daily and take corrective action as needed.
Create ACE rules and edits as needed to reduce claim denials and manual review.
Maintain ACE rules to ensure information remains current.
Run ACE edits daily and file paper and electronic claims with the appropriate payers.
Keep informed about coding regulations, auditing, professional standards, and company and department policies and procedures relevant to medical oncology, and apply this knowledge.
Communicate coding issues effectively to practice leadership to help ensure compliance and minimize denials.
Work cooperatively with team members and management and demonstrate a strong work ethic.
Travel to satellite clinics when necessary.
Lift up to 25 pounds.